Category Archives: Globalization

Foreign Patients Get Liver Transplants in US Hospitals First

ProPublica, those lovely folks who published several articles some time back on workers’ comp, are at it again.

This time, they are focusing their ire on how foreign patients are getting liver transplants at some US hospitals ahead of Americans waiting for such transplants.

The story, published yesterday, was co-published with a local Fox station in New Orleans.

From 2013 to 2016, New York-Presbyterian Hospital gave 20 livers to foreign nationals who came to the US solely for a transplant, essentially exporting the organs and removing them from the pool of available livers to New Yorkers.

Dr. Herbert Pardes (I was familiar with his name from living in NY), wrote that, “Patients in equal need of a liver transplant should not have to wait and suffer differently because of the U.S. state where they reside.”

Dr, Pardes was the former chief executive, and is now the executive vice president of the board at New York-Presbyterian.

Yet, according to the story, Dr. Pardes left out NY-P’s contribution to the shortage, as stated above from 2013 to 2016.

These 20 livers represent 5.2 percent of the hospital’s liver transplants during that time, which was one of the highest ratios in the country.

ProPublica reported that unknown to the public, or to sick patients and their families, organs donated domestically are sometimes given to patients flying in from other countries, who often pay a premium. Some hospitals even seek them out.

A company from Saudi Arabia said it signed an agreement with Ochsner Medical Center in New Orleans in 2015.

The practice is legal, according to the story, and foreign nationals must wait their turn in the same way as domestic patients. The transplant centers justify this on medical and humanitarian grounds, but at a time when we have an Administration touting “America First”, this may run counter to the national mood.

The  director of the transplant institute at the Mount Sinai Hospital in New York, Dr. Sander Florman, said he struggles with “in essence, selling the organs we do have to foreign nationals with bushels of money.”

Between 2013 and 2016, 252 foreigners came to the US purely to receive livers at American hospitals. In 2016, the most recent year for which there is data, the majority of foreign recipients were from countries in the Middle East, including Saudi Arabia, Kuwait, Israel and the UAE. Another 100 foreigners staying in the US as non-residents also received livers.

At the same time, more than 14,000 people, nearly all Americans, are waiting for livers, a figure that has remained very high for decades, they report. By comparison, fewer than 8,000 liver transplants were performed last year in the US, an all-time high. National median wait time is more than 14 months, and in NY, the time is longer.

In 2016. more than 2.600 patients were removed from waiting lists nationally, either because they died or were too sick to receive a liver transplant.

All this is happening at a time when the party in power is seeking to take health care away from those who recently received care for the first time in a long time from the ACA, and at a time when the medical travel industry is focused not on transplant surgeries, but on boutique treatments and surgeries for wealthy or upper middle class Americans to go abroad for bariatric, plastic or reconstructive surgery, knee surgery, dental care, etc.

And yet, when the very idea of medical travel is broached in the medical community, it is disparaged and discouraged by physicians and others as unsafe, impractical, and not worth the effort, Obviously, it is well worth the effort on the part of foreign patients to come here and take organs meant for Americans, so why not allow Americans to take their organs?

Is it because the hospitals that supply these organs to foreign patients are making huge sums of money, and the poor schnook American with liver disease (or kidney disease, as in the case of yours truly) must die so that an American hospital can improve its bottom line?

It is high time to cut the crap and promote medical travel the right way and for the right reasons, not only for those who can afford it, but those who need transplants and can’t get them here.

That is the true nature of the globalization of healthcare…a two-way street.

 

Ashley Furniture and Medical Travel, part 1

From the One Hand Washes the Other department comes the following Spotlight article from Medical Travel Today.com.

Ashley Furniture, based in Wisconsin, is one of the largest manufacturers of home furnishings in the world.

I met Rajesh Rao in 2014 when I attended the Costa Rican Medical Travel Summit in Miami Beach. Rajesh’s company was also instrumental in convincing another furniture manufacturer, HSM in North Carolina, to first send patients to India, then to Costa Rica for medical care. I have written about this in previous posts.

This article is part one, and part two will run next month.

The Dog Days of Summer

Now that the temperature has climbed into triple digits in some places, and others are feeling the heat of 90 plus degree days, I thought it would be good just to let my readers know that I am still here, even though I have not been writing much as of late.

Maybe that is because of the sudden death of David De Paolo and the industry is coming to grips with his tragic loss, it may also be that not much is happening as this is now summer vacation season, and people are away from the business world.

This time has given me an opportunity to concentrate on more personal matters that are of immediate importance to my well-being, and to reconsider the direction of this blog.

I have a vision, a vision some of you share, and a vision many of you cannot see, but as there are vested interests who stand in the way of progress in one industry my vision relates to, and the other industry is fixated on the “how”, and not on “why not”, and is plagued with doubts about just how big it really is, economically, as has recently been reported.

But a vision is not enough if there are barriers and obstacles and negativity surrounding it to transform the way things currently are done. There has to be a recognition that hard work and determination and perseverance are necessary to break down those barriers and obstacles, and faith in the efficacy of the vision is needed to turn a negative into a positive.

So, therefore I have decided to write less about the vision, and more about what is happening in the industry and in healthcare in general that I feel my readers would like to see. It does not mean I have given up; it just means that until the forces of globalization break the legal and financial barriers and obstacles standing in the way of medical travel for workers’ comp, and the industry itself comes to realize that it must change or go quietly into that good night that automation and artificial intelligence are leading it to, there is no point in pounding it into closed minds.

As for those who seek my explanation of “how” this could be accomplished, you are forgetting that this is not something that is already happening. There is no blueprint, no guidelines for opening up a closed system like workers’ comp to the rest of the world. It takes partnerships and brainpower and commitment, not some get rich quick scheme.

Those of you who ply your trade in medical travel are looking for the quick fix, the easy way out, and the rapid turnover of patients to medical facilities. It is not happening in general healthcare, and it certainly is not happening in workers’ comp, and not without sweat equity on your part.

I’ve said my piece for more than three years, and no one has seriously taken me up on this, so that is also why I am changing course. Medical travel will happen one day, but it won’t take conferences and meaningless certifications from fast-buck artists to make it happen.

One last note, I too lost someone recently who was a dear friend and mentor in my career. We met here in Florida in the 90’s. He died suddenly of a massive stroke, according to his wife, who answered his cell phone when I called him near two weeks ago. I learned about it the same week David De Paolo died. They will be missed. David by the industry he loved, and my friend by me.

Have a safe summer.

 

Foreign-born Workers on the Rise: What it Means for Work Comp and Medical Travel

Working Immigrants.com posted a report this weekend that indicated that the percentage of foreign-born workers in the US will rise from 16% to 20% of the workforce over the next 26 years.

It will grow for the next 15 years, then the pace will slow considerably. Citing a Census Bureau publication from March 2015, Working Immigrants said that the total population of the US is expected to grow from about 319 million in 2014, to 359 million in 2030, and 380 million in 2040, which is an increase of 19% over the next 26 years.

According to the report, the working age population will grow by 12%.

There is a higher rate of employment among foreign-born, due to the fact that they mainly come here to work, and they are more concentrated in working age brackets ― 80% between 18 and 64, vs 62% among native born.

Modest increases in the foreign-born population will result in higher shares of employment for these workers.

By 2040, foreign-born workers will be one fifth of the workforce.

It is a given that not many of these workers will have a great command of English, and the most likely foreign-born workers will be Hispanics and Asians.

A workforce that does not have a command of English, is mainly from Central and South America and Asia, will no doubt put a strain on an already strained social welfare system, especially workers’ comp, since they are more likely to be injured on the job.

So those of you in the medical travel industry looking for patients and trying to entice well-off Americans down to Latin America for dental work, cosmetic surgery, plastic surgery, and other treatments not available in the US or that are too expensive, should consider expanding your offerings to your fellow Latino immigrants, or change direction and consider doing so by offering to facilitate less expensive surgeries for common injuries found in the workers’ comp space.

And those of you in workers’ comp who have shut your minds to new ideas and refuse to listen to what I am saying, either should learn Spanish or Chinese, or deal with the changing nature of health care globally, and stop worrying about stepping on the toes of the vested interests, and start thinking about the interests of all those new foreign-born workers who will be coming here in the next 26 years (24 now that it is 2016).

They may not feel comfortable going to a hospital for surgery if the staff there does not speak their language, or the food is unfamiliar, and they may even recover faster if they know they are surrounded by friends and family in their home country. That will lead to a more productive and happier employee.

And a happier employee will improve your bottom line.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published 300 articles and counting, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

RIP GLOBALIZATION?

From all the commentary this weekend and on Friday about the referendum to leave the European Union (EU) in the UK, it would seem that the dream of a handful of international bankers, multinational corporation heads and politicians of both the left and the right since the end of the Second World War have made a terrible and unforeseen error in pushing for a globalized world economy.

How did we get to this place? Simple, as a result of the economic policies of the 1920’s and 1930’s, Europe and her allies in North America, were plunged into a second global conflict. Near the end of the conflict, the economic leaders of the Allied nations gathered in Bretton Woods, NH to carve out the Bretton Woods Agreement, which established the World Bank and the International Monetary Fund.

Along with this, came the United Nations to deal with the political and military crises that would arise in the second half of the twentieth century. To provide greater perspective, we must go back to the First World War and recognize that here in the US, many Americans were woefully ignorant not only about world affairs, but of geography as well. In 1914, I doubt many Americans could point out just where Sarajevo or Serbia was, or where any of the other nations drawn up into that war were located.

Following on the heels of an earlier organization, the National Civic Federation, several prominent business, political, academic, labor and other leaders formed the Council on Foreign Relations. The Council promoted the study of geography and political science in colleges and universities, as well as promoting social studies in high schools and junior high schools.

The Council also published Foreign Affairs magazine, which became a forum for the discussion of world events and dissemination of political theories and policies from leading academics and business leaders. But there was one other thing that the Council did. It provided the US government with its future Secretaries of State, War, Treasury, and later Defense, among other lesser administration positions from the 1920’s onward.

My first major in college was political science, and more specifically, international relations and foreign policy. I also had a graduate course in American Foreign Policy at NYU as part of my History Masters degree.

After WWII, the Cold War forced many of the Western countries to realize that in order to defend against Communism, as they had against Fascism, they needed to have greater cooperation. So the North Atlantic Treaty Organization, or NATO was born, and within Western Europe, the idea of European cooperation led to the formation of the Common Market, of which the UK was a member.

In the 1950’s and 60’s, the European Coal and Steel Community (ECSC) and  was created, followed by the European Economic Community (EEC). These developments were spelled out in the Brussels Treaty of 1948, the Paris Treaty of 1951, the Modified Brussels Treaty of 1954, and the Rome Treaty of 1957.

In the 1960’s, the Merger Treaty of 1965 created the European Communities, made up of the European Atomic Energy Community (EURATOM), as well as the  ECSC and EEC.

The Maastrict Treaty of 1992 created the European Union, and its membership has grown steadily, especially after the fall of Communism in Eastern Europe and the breakup of the Soviet Union and Warsaw Pact.

Meanwhile, in other regions of the world, similar ideas were taking shape. In Asia, the Association of Southeast Asian Nations (ASEAN) was formed to do for Southeast Asia what NATO and the European Communities were doing for Europe.

To foster greater cooperation between North America, Western Europe and Japan, the three industrial regions of the world, David Rockefeller, Chairman of Chase Manhattan Bank and Zbigniew Brzezinski created the Trilateral Commission. In the next two decades, membership in the Commission was expanded to every other region of the world.

Like the Council on Foreign Relations, members of the Commission could be involved in politics in their respective countries, but once they achieved national office of any kind, they resigned from the Commission. Membership was recommended by current members, and the incoming Jimmy Carter Administration of 1977-1981 saw the following members leave the Commission: Jimmy Carter, Walter Mondale, Harold Brown, Zbigniew Brzezinski, Cyrus Vance, among many others.

It was in college that I studied global politics, or what would become known as Globalization, and with the expansion of the Commission’s member countries, and the fall of Communism, it seemed that globalization would continue.

Yet, they made one big mistake. Neglecting to replace the jobs lost to globalization from the 70’s to the present and thinking that “free trade” conducted through treaties such as NAFTA, CAFTA, TPP, and under the approval of the WTO would benefit both the developed and underdeveloped worlds. Hardly, as the Brexit vote and the rise of Trump in the US, as well as Bernie Sanders on the left can testify to.

Globalization has been mostly a one-way street out of the developed countries and into the undeveloped or developing countries. It has had the unintended consequences of stirring up racism, bigotry and resentment, as well as distrust in institutions and government. It has also favored the wealthy and those international players already in the game, but locks out those who are attempting to benefit from it, as many in the medical travel industry have tried and failed to do.

With other European nations threatening to leave the EU, and opposition here to TPP, and other trade deals (“I’m going to make better deals”), it would seem that globalization, far from dead yet, may at least be stopped in its tracks for the foreseeable future. That may happen if the US does the stupid too, and elects a moron.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

ERISA, Stop Loss and Unintended Consequences

“The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”

John F. Kennedy

“Some men see things as they are and say why. I dream things that never were and say why not.”

Robert F. Kennedy

“It is not because things are difficult that we do not dare, it is because we do not dare that things are difficult.”

Seneca

Those quotes were included at the top of my June 19, 2013 post, “Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation” where I defended myself against the charge that I was offering “simplistic solutions” to medical travel and workers’ comp. In that post, and in “The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream” I acknowledge that is won’t be easy, but there are ways to do it.

In my last post, “Self-Insured Employers Fail To Adopt Medical Travel“, I discussed the reasons given by Irving Stackpole for why US employers have failed to adopt medical travel into their corporate health plans.

In conversations with a noted ERISA and medical travel expert, I have been making the case that laws and regulations such as ERISA, Stop Loss, and other “barriers” erected decades ago, in order to address specific problems such as tort claims, aggregate claim losses, etc., have the unintended consequence of holding back the globalization of health care, which includes workers’ comp.

I have addressed the legal barriers in comp in my White Paper, and found that there were outdated federal and state laws and regulations, intended to protect consumers, actually increase costs and reduce convenience, restrict public providers from outsourcing certain expensive medical procedures, and that federal laws inhibit collaboration, while state licensing laws prevent certain medical tasks being performed by providers in other countries.

Let me state here that I, in no way, am advocating the removal of these laws and regulations. My chief argument is this: our best minds have split atoms, launched satellites and men into space, discovered cures for diseases plaguing humans for centuries, but to send patients to other countries for medical care is impossible, and not worth pursuing, smacks of cowardice or fear that it actually might save money and provide better care. Do we not have the best minds to figure out how to deal with these “barriers”, or are we too fearful and litiginous a society that we have given up accepting new ideas?

Every industry is being affected by two powerful forces today: globalization and automation. With globalization, jobs, plants and other forms of capital are moving across borders. With automation, jobs that were once held by humans and considered very dangerous, are being done by robots, and soon other jobs will be done by artificial intelligence.

Neither force can be stopped, and how we address the consequences of these forces is what many minds are working on right now. But to say that one industry is going to draw a line in the sand and say, “NO” and stop globalization from happening is either insanity or a deliberate attempt to profit from the maintenance of the status quo that many along the supply chain of medical care services, both within the general health care space and workers’ comp have carved out for themselves.

When I was in college, I studied International Relations, and back then, globalization was a word very few outside of academia ever heard. There was an organization created in 1973 by David Rockefeller and Zbigniew Brzezinski called the Trilateral Commission. Its purpose was to foster better cooperation between the countries in North America, Western Europe and Japan (the Trilateral countries) and their multinational corporations. In the ensuing decades, the Commission expanded the membership to the rest of the world, and globalization became a household word.

Coincidence? I think not, since the heads of major US, Western European, and Japanese companies were members, and so were many politicians, including a former peanut farmer from Georgia and most of his top administration personnel. Other politicians after him also have been members, from both sides of the political spectrum.

Their chief goal is to allow capital, goods and jobs to cross national borders, or to eliminate them altogether, and I doubt they expected the health care industry to stand in their way. These are men who generally get what they want, and damn the consequences. We see this in the breakup of the European Union, which many of them advocated for years, just like they advocated for NAFTA, CAFTA, the TPP, and other trade deals, and don’t give a fig about the impact they have.

So, it is important to realize that the only real thing preventing medical travel is what unintended consequences have on the growth and development of the industry. This is where the industry needs to focus its attention, not on slick advertising, but on hard work and cooperation to overcome these “barriers”.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.

RESISTANCE IS FUTILE!: What is the reason behind Medical Tourism’s Rejection?

My friend, Maria Todd, PhD, noted International Expert on Healthcare & Health Tourism Business Strategies & Operations, Business Owner, Author, and Speaker, has written a very cogent and to the point article challenging American hospitals on why they eschew inbound medical tourism.

For the uninitiated, inbound medical tourism, or travel, refers to foreign patients traveling to the US or other countries for medical care from their home country.

A case in point was the late, and not lamented, Shah of Iran who was allowed to come to the US for treatment of his cancer, and which led to the taking hostage of our embassy staff, destroying what was left of one presidential administration, and secretly aiding another to win the election, and thus look good in the eyes of the American people, only some time later to that administration selling arms to Iran for other hostages, the cash then used to support the Contras in Nicaragua.

But I digress.

As the Shah had money, he was welcomed with open arms, but Maria wonders why other American hospitals, knowing that they will receive cash, still refuses to seek out inbound medical tourism as an alternative source of revenue.

According to Dr. Todd, “It is estimated that the USA is the 3rd most popular destination for inbound medical tourism from other countries, but the practice of traveling for health has been a “thing” in the USA for more than 100 years.

Corporations such as Pepsico, Lowe’s Home Improvement, Boeing, WalMart and many other corporations, she writes, with self-funded health plans under ERISA, have the freedom to contract with any hospital, anywhere in the world without going through a managed care network, but can’t because the hospitals with lots of value to offer simply don’t seem interested enough to talk to them.

She wants to know why not? In order for her to find the answer to that and other questions, she is asking her colleagues in healthcare business development and business administration who are executives at leading healthcare institutions and well-equipped ASCs across America: “Why do you eschew medical tourism business?

This question, and the others that she poses in her article, also relate to outbound medical tourism as well.

Why do employers, insurance companies, the domestic health care industry, which is beset by so many problems and potential shortages and inefficiencies, as well as the entire workers’ compensation industry eschew medical travel for non-work-related illnesses and diseases, and work-related injuries requiring surgery?

I’ve written about this many times before. I have cited American Exceptionalism, racism, xenophobia, greed, ignorance of the quality of medical care abroad, and many other factors, but as Maria points out for US hospitals turning down cash patients, employers and carriers can save money by looking outside our broken and dysfunctional medical care system under workers’ comp.

It’s high time the US joins the rest of the world, and allows our citizens the freedom to go wherever they want for medical care, no matter what the cause, or condition that prompts them to seek medical care that is high quality, and will save money for their employer, and provide them an opportunity to see the world that also belongs to them.

Not to do so is tantamount to enslavement to a corrupt and rigged system that benefits unscrupulous physicians, pharmacies, pain management centers, and other workers’ comp service providers, and harms injured workers.

Medical travel will happen. Resist at your peril.